Elder Care

Steps for Finding the best Elderly Homecare

Those of us who are fortunate that our parents are still with us face the issue of having to provide care for them as their ability to manage for themselves slowly fades. Despite their slow but steady loss of their abilities of independent living many are, understandably, determined to stay in their own homes. That’s when the discussion of alternatives, including homecare, becomes unavoidable for even the most independent minded folks.

Homecare provides people the advantage of staying in their homes and maintaining independence, while providing required medical care.  Elderly homecare may be necessary for a variety of persons, such as those with acute injuries (hip replacement), and chronic ones (stroke).   The skills required of homecare providers vary as well.

Types of Homecare Personnel

Homecare aids:  Certified Nurse Assistants, or CNAs, provide assistance in bathing, feeding, hygiene, and toileting needs.  They are generally useful for chronic, long-term care persons.

Registered Nurse:  RNs are able to provide medications, wound dressing changes, and obtain vital signs.  RNs are useful when skilled, acute care is needed.

Therapists:  Physical and Occupational Therapists provide skills for speech and motor rehabilitation when acute care is needed.

Getting Homecare

The National Family Caregivers Association provides information on homecare.  The first step “is to make sure you and your loved one are comfortable with the idea of someone else taking on some of the tasks that you’ve been doing by yourself.”  After that, the specific tasks needed should be determined.  This will help to define the type of homecare personnel needed.

Federally funded programs, insurance, and health maintenance organizations (HMOs) may or may not cover the services you require.  Personal care tasks are usually not covered by private insurance or Medicare.  Long-term-care insurance usually covers services required, but not all Americans have it.  Unfortunately, “more often than not the costs of homecare services will have to come out of your own pocket” (NFCA).

Accreditation of Care Agencies

Some agencies may be accredited, which is a step beyond certification.  Accreditation signifies conformity to national industry standards.  Some well-known homecare agencies that provide accreditation are: the National League for Nursing, the Joint Committee for Accreditation of Healthcare Organizations, and the National Foundation of Hospice and Home Care.

Cost of In Home Care

Agencies vary in their costs.  Visits by RNs and therapists are more valuable and costly than those by CNAs.  Some agencies charge a flat fee for each visit (about $100).  Some have a minimum two or four-hour fee.  Rates may be from $13 to $35 an hour.

Questions to Ask the Eldercare Agency (from NFCA)

  1. Is the agency certified in Medicare and/or Medicaid programs? (if needed)
  2. How long has the agency been in business?
  3. Is the agency accredited by a recognized body?
  4. Is an initial assessment provided to determine if homecare is appropriate?
  5. Are the services you need provided by the agency?
  6. How are employees chosen and trained?  Are background checks mandatory?  Are caregivers given written personnel policies, benefit packages, and mal-practice insurance?
  7. Are emergency procedures in place?
  8. Are any references available from clients?

The National Association for Home Care & Hospice (NAHC) agency locator can be found here.  NAHC home health comparisons, surveys, facts, and statistics can be found here.

Elder Care

How to Find a Nursing Home

Sending a loved one to a nursing home is one of the hardest decisions a person will have to make.  The many options can be overwhelming, and the number of nursing home “horror stories” doesn’t make the choice any easier.  But with research and determination, it is possible to find a good nursing home.

Nursing homes can be like hospitals or like households.  In the hospital-like setting, staff provides medical care, occupational therapy, and speech therapy.  There is usually a nurses’ station on each unit.  In the household-like setting, the environment is much more like a home.  For example, residents can use the kitchens and do activities on their own schedule. (NIA).

Federal law requires certified nursing homes to have at least one Registered Nurse for at least 8 hours a day, 7 days a week.  An RN or Licensed Practical Nurse (LPN) must be on duty 24 hours.  Certified Nursing Assistants (CNAs) are on staff 24 hours a day.


The Centers for Medicare and Medicaid Services (CMS) inspect the more than 15,000 nursing homes in the United States.  If the nursing home doesn’t pass inspection, it isn’t certified.  The nursing homes are then ranked based on health inspection, staffing, quality measures, fire safety, and payment options, with a score of one to five stars.  The Medicare and Medicaid government website to compare nursing homes in your area is found here.

Only the top 10% of nursing homes in each state are given a five-star rating.  However, this could be misleading the data gathered are from a short period of time.  Additionally, many four-star nursing homes could be very similar to five-star nursing homes, just a couple points shy of the 10% cut-off.

The website provides information on nursing home comparisons, checklists, payment options, resident rights, and other useful information.  They also offer a useful brochure and nursing home checklist.

The Visit

One of the most important parts to choosing a nursing home is visiting it.  Even if a nursing home looks good on paper, if it smells like urine it may not be a good choice.  It is important to observe the staff and their interactions with each other and with the residents of the nursing home.  After your first visit, make a second visit unannounced, but at a different time of day than you did before.  Observe residents at mealtime to see if they like the food they are eating.  (NIA).

During your visit, has a list of things to look for:

  • Are there unpleasant odors?
  • Are residents clean, dressed, out of bed, and interacting with staff?
  • Is the noise level unusual?
  • Does the facility look clean?
  • Does the home seem like a safe place to live?
  • Are residents involved in activities?
  • Are staff visible, helpful, friendly?
  • Does the home “feel” warm, as a home should?

It is a good idea to meet with the head nurse and physician if possible, as well as the director of the nursing home.  If they are constantly unavailable or unable to meet with you, it could be a bad sign.  Also talk to the nurse assistants, dietary staff, and activity directors.

Ask the nursing home what percentage of staff leave each year.  30% is considered normal, 50% may be a bad sign.

“Person-centered care” and “consistent assignment” are two terms that may signify the nursing home is a good choice.  Person-centered care means that the nursing home residents are able to eat and sleep on their own schedule, not according to the wishes of the staff.  Consistent assignment means that the same staff members are taking care of the residents everyday.  This promotes deeper and more engaging relationships between the staff and residents, and is also thought to decrease turnover.


Medicare only pays for medically necessary care in a nursing home (IVs, physical therapy).  It does not cover custodial care (bathing, eating, assisting).  Additionally Medicare only pays for the first 100 days in a skilled nursing home.  After that, Medicaid may pay for long-term programs, but there are many rules to qualify.

Medicaid provides benefits to those with low incomes, and may help pay for a nursing home.

Some pay privately with their own savings, and then use Medicaid when needed.  If you suspect this may happen, make sure the nursing home accepts Medicaid.

Another payment option is long-term care insurance, which is purchased privately and can pay for part of the nursing home cost.  The benefits vary.  (NIA).


An ombudsman is a federally funded advocate of nursing home residents.  They will be able to provide nursing home rankings in addition to those done by Medicare.  You can find your state ombudsman here.

Elder Care

Protecting the Elderly from Heat Stroke

The National Institute on Aging (NIA) lists the following health-related factors that may increase risk of hyperthermia (high body temperature) in the elderly:

  • Poor blood circulation and inefficient sweat glands
  • Heart, lung, and kidney disease
  • Salt-restricted diet due to high blood pressure
  • Inability to perspire caused by diuretics, sedatives, and some blood pressure medications
  • Being very overweight or underweight
  • Drinking alcohol
  • Being dehydrated

The NIA says that older people should stay inside when it is hot and humid, especially if there is an air pollution alert.  It is crucial that people without air conditioning or fans go somewhere that has air conditions.


Heat cramps result in painful tightening of muscles.  They are the first signs that your body is too hot, and needs fluids.

Heat syncope, or dizziness, can occur when people are taking a beta-blocker for their heart and are not used to hot weather.  Putting one’s legs up and resting will stop the dizziness.

Heat exhaustion is the last stage before heat stroke.  It is a warning sign that your body cannot cool itself anymore.  Symptoms include thirst, dizziness, weakness, nausea, and profuse sweating.  Body temperature will remain normal, but skin becomes cold and clammy.

Heat Stroke

Heat stroke results when body temperature reaches above 104 degrees Fahrenheit.  Symptoms include confusion, combativeness, strong rapid pulse, lack of sweating, dry flushed skin, faintness, staggering, and possible coma.  People with heat stroke must seek immediate medical attention.  While waiting for help to arrive, move the person to a cooler place and offer fluids (but not alcohol or caffeine).  Apply cold, wet cloths to the wrist, neck, armpit, and groin, or help them take a shower.

The NIA says:  “Hundreds of people die from hyperthermia each year during very hot weather.  Most are over 50 years old.  The temperature outside does not have to hit 100 degrees Fahrenheit for you to be at risk for a heat-related illness.”

Elder Care

Family Caregivers

When elderly parents or loved ones age, their needs may become more demanding. But sometimes when help is offered, elders may feel reluctant to take it.  Recognizing that help can make a difference in both people’s quality of life may make people more open to receiving help.  After all, asking for help is a sign that you truly have a grasp of your situation, and you know exactly what needs to be done.

Family Caregivers

The National Family Caregivers Association connects caregivers to each other and disseminates caregiving research and information.  Family caregivers are family, friends, partners, and neighbors.

The National Alliance for Caregiving reports “More than 65 million people, 29% of the U.S. population, provide care for a chronically ill, disabled, or aged family member or friend during any given year and spend an average of 20 hours a week providing care for that loved one.”

Suzanne Mintz, President/CEO of NFCA says, “Caregiving is very lonely.”  Caregivers can feel very isolated, especially when dark emotions or thoughts enter their minds.  The NFCA gives comfort by connecting caregivers to each other, allowing them to communicate feels of frustration or sadness in a healthy way.

The National Alliance for Caregiving and Evercare reports that caregivers form a workforce that provides $375 billion a year of unpaid care.  This is almost twice as much as the amount spent on homecare and nursing homes combined ($158 billion).

NFCA research efforts have focused largely on family caregivers who provide a significant level of care.  For more information on research efforts, click here.

Caregiver Wellbeing

Many people choose to be family caregivers either because they cannot afford otherwise or because they feel they cannot entrust the care of their loved one to someone else.  Their lives are often altered, with six in ten caregivers being otherwise employed.  Stress, depression, and poor diet are common in many caregivers.  It is important for caregivers to take care of themselves as much as possible, although this is easier said than done.

The NFCA provides these ten tips for caregivers:

  1. Caregiving is a job and respite is your earned right.  Reward yourself with respite breaks often.
  2. Watch out for signs of depression, and don’t delay in getting professional help when you need it.
  3. When people offer to help, accept the offer.
  4. Educate yourself about your loved one’s condition and how to communicate effectively with doctors.
  5. There’s a difference between caring and doing.  Be open to technologies and ideas that promote your loved one’s independence.
  6. Trust your instincts.
  7. Caregivers often do a lot of lifting, pushing, and pulling.  Be good to your back.
  8. Grieve for your losses, and then allow yourself to dream new dreams.
  9. Seek support from other caregivers.  There is great strength in knowing you are not alone.
  10. Stand up for your rights as a caregiver and a citizen.
Elder Care

Monitoring Technologies for the Elderly

QuietCare is a home health alarm system provided by ADT Security Services.  Its wireless sensors track the movements of elders in their homes without video cameras.  The software allegedly is able to determine if the person got out of bed in the morning, ate, and taken their medicine. Changes in the resident’s activities are analyzed, and caregivers can be alerted if there are problems.  Operators at the 24-hour call center are trained in emergency situations.  Installation is $199, and the monitoring begins at $79.95 a month.

Medical Alert is a elderly monitoring system that provides help “at the push of a button”.  The system allows you to communicate with “a professional monitoring team member” who can dispatch EMS.  They also inform the EMS of existing medical conditions, and say this information is “kept strictly private.”  The company says that the self-installation takes 5 minutes.  It includes a base unit that is connected to the power and phone line, and an emergency button that can be used on the wrist or as a clip-on.  There is a $29.95 per month monitoring fee.

Six out of 10 people with Alzheimer’s disease will wander and become lost.  The Alzheimer’s Association Safe Return program connects those who have become lost with their caregivers.  It provides identification products (necklaces, bracelets, wallet cards, and clothing labels) with the toll free 800 number to a national information and photo database.  Anyone who finds an Alzheimer’s patient can call this phone number, and the caregiver will be notified.  There is a $40 registration fee.

“Granny Cams” in Nursing Homes

According to the National Institute of Health, there are 1.6 million Americans in nursing homes.  Recent horror stories about nursing home neglect and abuse has prompted a broad coalition of advocates who are calling for a federal law mandating the installation of a “granny cam” in nursing homes.  These advocates believe that it will prevent abuse of the elderly by their caregivers, but many nursing homes are saying it is an invasion of the elderly residents’ privacy.

“The federal government estimates that violations in <25% of homes substantially harm residents” (NIH).  Advocates of a federal law that allows cameras to be installed say that it would only be done with the permission of the resident, and that caregivers would be made aware of the camera.  The cameras cost $200 to $500, and would be paid for by the families of residents.

“With nursing home patients expected to increase by 350% to nearly 6 million by 2040, nursing home care needs to be improve, and maybe the ‘granny cam’ is the way to do it” (NIH).

Future Developments

Researchers at the University of Houston’s College of Technology are designing “an affordable in-home health-monitoring system that will notify caregivers, via smartphones or PDAs, if their loved ones need attention.” (UH).

The system monitors vital signs (blood pressure, temperature, pulse, and respirations) and location of the person by a sensor the size of a quarter.  There would be a few sensors in various rooms that would communicate with the sensor the person is wearing, as well as a central hub.  This would be connected to the Internet and send alerts to the caregiver’s smartphone or PDA.

The system uses off-the shelf technology, which makes it affordable.  Researchers say that $1000 could wire an entire house.  It is also designed to be easy to use.

Elder Care

Promoting “Good” Days for People with Dementia

The Alzheimer’s Foundation of America says that sticking to a daily routine for people with Dementia is a necessity.  It helps both the Alzheimer’s person and caregiver to get through the day easier, and it helps to maintain the abilities of the person with Alzheimer’s.  For example, involve the person in their usual habits, and do not disrupt their usual routine.  In addition to maintaining their skills and activity level, participating in daily activities can relieve tension for those dealing with dementia.

Understanding the Behavior

According to the Alzheimer’s Association, Alzheimer’s disease can cause unpredictable and different behaviors, such as aggression and anxiety.  These reactions can cause misunderstanding, tension, and frustration with caregivers.  The Alzheimer’s Association lists the following possible conditions as being responsible for behavior: physical discomfort, overstimulation, unfamiliar surroundings, complicated tasks, and frustrating interactions.  They recommend this three-step approach:

  1. Identify and examine the behavior, including what happened just before it occurred.
  2. Explore potential solutions, such as the needs of the person with Alzheimer’s and the possibility of adapting surroundings for their better comfort.
  3. Try different responses, if your response didn’t help the first time.


Aggressive behaviors may be verbal, physical, or both.  They may occur suddenly without reason or as a result from a particular situation.  The best way to deal with aggressive behaviors is to identify the cause, and then make necessary changes.

The Alzheimer’s Association makes the following suggestions for how caregivers should respond to aggression in people with Alzheimer’s:  Identify the immediate cause, focus on the person’s feelings, not facts, do not get angry, limit distractions, try a relaxing activity, and shift the focus to another activity.


People with Alzheimer’s may not recognize people or places that use to be familiar to them.  They can become confused easily, and forget what they are doing in the middle of an activity.  The best way to respond to a confused Alzheimer’s person is to stay calm, respond with brief explanations, show photos to spark memories, and try not to take their forgetfulness personally.


Sometimes, people with Alzheimer’s may become suspicious and paranoid of people around them, may make false accusations, and may misinterpret what they see or hear.  The best way to respond to this is do not take offense, be reassuring, don’t argue or try to convince, and offer simple answers.

Overall, the most important thing you can do for a person with Alzheimer’s disease is to be there for them and provide unconditional love.  Having a calm, stable, and predictable environment will reduce behavioral problems.  Involving them in daily activities will maintain their abilities and reduce anxiety.